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Health Education

What causes spotting before your period? Related conditions and treatments

Spotting is completely normal, but see your healthcare provider if it becomes a pattern
Wendy Wisner
By | Jan. 12, 2024 Medically reviewed by Laura K. Grubb, MD, MPH

It’s not uncommon to experience light spotting, even though you’re not due for your period, but it can still be frustrating to wonder whether it is just spotting or a sign of your period coming early. 

“Spotting is usually light bleeding that may or may not require a pad—sometimes it is just noticed when wiping,” says Kevin W. Hamburger, MD, OB-GYN at Siouxland Women’s Health Care. “Period bleeding is usually heavier and continuous for a few days to a week.” Dr. Hamburger says that it’s common to spot a day or two before your full period comes and that it is not a cause for concern unless it becomes a pattern. It’s possible to have light cramping with the spotting, especially during the few days leading up to your period.

 Key takeaways:

  • Spotting before a period is a common symptom that may be caused by normal hormonal fluctuations during your menstrual cycle and sometimes by certain health conditions or lifestyle changes.
  • Typically, spotting before a period does not require immediate medical attention.
  • Spotting typically resolves without treatment within a few days or after a few menstrual cycles.
  • Treatment of spotting before a period may include watching and waiting, hormonal treatments, medications to reduce menstrual bleeding, and surgeries to remove cervical polyps or fibroids.

What causes spotting before a period?

A typical menstrual period lasts between two and seven days and occurs every 21 to 35 days. Although we think of menstrual periods as times of moderate to heavy bleeding, sometimes they start light, with what looks like spotting. As such, most cases of spotting before a period are simply normal variations of bleeding patterns.

“Spotting before your period is quite common and usually not a reason to worry,” says Shandra Scruggs, RN, labor and delivery nurse, doula, and the founder of Simply Birthed. “It’s often linked to hormonal changes that naturally happen in your menstrual cycle.”

Still, sometimes spotting before a period has other causes.

Stress and lifestyle changes

Stress and lifestyle changes can affect your hormones, which can sometimes lead to spotting before a period. “Stress, especially high-stress levels, can mess with your hormones and lead to spotting,” Scruggs says. Additionally, many circumstances and life stressors can affect hormone levels, causing spotting. “This includes illness, stress, new medications, and weight changes,” adds Dr. Hamburger.

Weight loss or weight gain can change the frequency, timing, amount of bleeding, length of bleeding, and more. This is usually due to the change in estrogen levels that occur with weight fluctuations.

Polycystic ovarian syndrome

According to Cleveland Clinic, hormonal imbalances, including conditions like polycystic ovarian syndrome (PCOS), can cause spotting before a period. When you have PCOS, your ovaries produce excessive amounts of androgen hormones, which cause you to have irregular periods and unpredictable or absent ovulation. This may mean that your periods are few and far between or that you experience abnormal bleeding. Some people also experience heavier than normal bleeding.

Endometriosis

As the American College of Obstetricians and Gynecologists (ACOG) notes, endometriosis is a common cause of abnormal bleeding. With endometriosis, your uterine tissues grow in areas outside of your uterus, including your bowels, ovaries, fallopian tubes, vagina, and bladder. Pain is the most common symptom, but other symptoms include lower back and pelvic pain, pain during sex, and spotting between periods.

Ovulation

Any type of issue with ovulation can lead to potential spotting before periods or irregular bleeding, according to the ACOG. For example, if you don’t ovulate for a few cycles in a row, the lining of your uterus can become too thick, leading to irregular bleeding, which can range from light to heavy.

Perimenopause

Perimenopause is defined as the years leading up to menopause, which is the cessation of having monthly periods. During this transition, irregular periods are common, according to ACOG. This includes longer periods, spotting before and between periods, or having lighter or heavier periods than normal.

Hormonal birth control

Taking hormonal birth control can sometimes cause irregular bleeding and spotting before your period, according to MedlinePlus. If you are using birth control pills, this can happen when you skip a dose. “The most common reason I have seen for spotting is when women forget to take their contraceptive pills,” Dr. Hamburger says. “Since some birth control pills are so low dose nowadays, missing even one dose can cause breakthrough bleeding.” Dr. Hamburger says that spotting is also common when using contraceptive implants like Nexplanon. Combined estrogen and progesterone contraception (pills, patch, ring) may be used to regulate abnormal periods. Some progesterone-only contraceptives (Nexplanon implant, Depo Provera injection, and hormonal Intrauterine Devices) commonly have irregular menstrual bleeding.

Cervical polyps

“Spotting before your period, and especially after vaginal intercourse, is often caused by a cervical polyp,” says Dr. Hamburger. Cervical polyps are benign, small growths found on your cervix that can bleed easily. Your gynecologist may spot them during a pelvic exam, and they can be removed if they are causing issues.

Sexually transmitted infections

Sexually transmitted infections (STIs), such as chlamydia, trichomonas, herpes, and gonorrhea, may cause abnormal bleeding between periods, according to Mayo Clinic. Other possible symptoms include unusual vaginal discharge, pelvic pain, pain or burning when peeing, and pain during vaginal intercourse. STIs can also lead to a complication called pelvic inflammatory disease, which is a serious infection of the reproductive organs that can cause symptoms that include bleeding between periods.

Fibroids

Fibroids are benign growths that occur inside your uterus, in the uterine muscle wall, or on the outer surface of your uterus. Many people have no symptoms, but abnormal bleeding, including spotting between periods, is possible. Other symptoms may include heavy menstrual bleeding, cramping, pelvic pain, pain during sex, and lower back pain.

Pregnancy

It’s common to experience spotting during early pregnancy, such as when you expect your period. This can be a sign of implantation bleeding, which is spotting that occurs when your fertilized egg implants into the uterine lining. According to the ACOG, between 15% and 20% of women experience bleeding in early pregnancy, either from implantation bleeding or increased blood flow to the cervix. If your bleeding is heavy or accompanied by severe cramping, nausea, or shoulder pain, you should contact a healthcare provider, as these symptoms may be signs of a miscarriage or ectopic pregnancy.

Cervical or endometrial cancer

Although a much less common cause of spotting before periods, sometimes cervical cancer or endometrial cancer (cancer of your uterine lining) can lead to spotting or irregular bleeding, according to MedlinePlus. When it comes to cervical cancer, there are often no symptoms in the earlier stages. Spotting between periods, bleeding after sex, or having longer than usual periods are some of the potential symptoms once the condition advances. Endometrial cancer usually affects older postmenopausal women in their mid-60s, according to the ACOG, and abnormal bleeding is one of the earliest symptoms. Thus, it is important that you stay current on regular screening for cervical cancer.

Should I be worried about spotting before my period?

Spotting before your period is normal, and almost all women experience it at one time or another. The Cleveland Clinic reports that between 10% and 35% of women experience abnormal uterine bleeding, which may include spotting before periods. Irregular bleeding is most common when girls first get their periods and also during the menopause transition (perimenopause).

Generally speaking, if you experience spotting before your period for a cycle or two, and no other concerning symptoms, there is usually nothing to worry about. But if it continues, you may need to reach out for help. “If it becomes repetitive or a pattern, you should be evaluated by your doctor,” says Dr. Hamburger. Additionally, any vaginal bleeding after menopause should be evaluated by a gynecologist, as this is never normal, Dr. Hamburger emphasizes.

Besides the duration of spotting, there are other symptoms or circumstances that may warrant a visit to your healthcare provider. “These circumstances may include consistent or prolonged spotting before every period, heavy bleeding outside of the normal menstrual cycle, severe pain or cramping along with spotting, pain during vaginal intercourse, and new or unusual symptoms like fever, chills, pelvic pain, or abnormal vaginal discharge,” says Scruggs. These signs could indicate an underlying condition or infection, she explains.

If you know you have a medical condition that could cause spotting, like endometriosis, PCOS, fibroids, or cervical polyps, you may consider reaching out to your provider to see if your spotting is a sign that the condition is worsening. Complications can arise from spotting before a period, depending on the cause, which is why you should see a provider if your spotting symptoms aren’t going away or are accompanied by other symptoms.

Most of the time, spotting on its own doesn’t require a trip to the ER, and you can schedule a visit with your healthcare provider to discuss any concerns. However, if you begin to develop heavy bleeding (soaking through a pad or tampon within an hour for two to three hours), severe cramping, fever, or dizziness, you should contact emergency services.

How is the cause of spotting before periods diagnosed?

If your spotting persists or is accompanied by other concerning symptoms, you should make an appointment with your primary care provider, gynecologist or OB-GYN. According to the American Academy of Family Physicians (AAFP), if you visit a healthcare provider for unusual bleeding, you should come to the appointment with a list of any medications or supplements you are taking and any notes on your periods, including start and end dates and symptoms.

Your doctor may ask you questions about your periods, including when the spotting takes place, what color and consistency it is, and any concurrent symptoms you have. They may also need your full medical history. It can be helpful to track periods on a calendar or a menstrual period tracker app.

Finally, your doctor may perform a series of tests and exams to understand what is causing your spotting, including:

  • Pelvic exam
  • Pregnancy test
  • Urine tests for sexually transmitted infections
  • Blood tests
  • A transvaginal ultrasound, which uses sound waves to see your uterus and ovaries
  • An endometrial biopsy, which involves taking a sample of your uterine lining to look for cancer cells
  • A cervical cancer screening, if you are not up to date

How long does spotting before a period last?

Spotting before a period varies from one person to another. “In many cases, it may last a few hours to a few days,” says Scruggs. “Some women may notice just a slight bit of spotting for a short time, while others might experience it for a longer duration.” If it lasts for the entire month, that’s a sign you should visit your healthcare provider, Dr. Hamburger says. 

How to stop spotting before periods

“If spotting before your period is minimal and doesn’t last for more than a few menstrual cycles, it will likely just go away on its own,” Dr. Hamburger says. “Spotting is usually more annoying than dangerous, but if it persists, call your healthcare provider.”

When spotting is indicative of an underlying medical condition, you may require specific treatment. The type of treatment you need depends on what condition is causing your spotting. Here’s what to know about treatment for spotting.

Medications

The following medications can be used to treat abnormal bleeding, according to the ACOG:

Surgeries

Sometimes, surgeries or other procedures are required to treat conditions that cause abnormal bleeding. These may include:

  • Removal of cervical polyps
  • Surgeries to remove fibroids
  • Surgeries to address endometriosis
  • In individuals who are not looking to get pregnant, a procedure called endometrial ablation, which reduces the uterine lining 
  • In some cases, a hysterectomy (removal of the uterus)to treat fibroids and endometrial cancer when other types of treatment have failed or are not an option

Bottom line

Spotting before period  may be due to normal hormonal variations, sexually transmitted infections, fibroids, cervical polyps, endometriosis, hormonal birth control, perimenopause, and other causes. In most cases, the cause of spotting before a period may resolve on its own without treatment. If spotting before a period continues, worsens, or is accompanied by severe cramping, fever, pelvic pain, or dizziness, it could be a sign of ectopic pregnancy, pelvic inflammatory disease, or an STI. Only your healthcare provider can rule out infection or other serious health conditions. Visit your healthcare provider to determine the best treatment for spotting before a period.

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